Healthcare communications – how to influence behaviour change
pharmafile | August 23, 2011 | Feature | Medical Communications |Â Â communications, healthcare communicationsÂ
For decades, healthcare communications has used a fixed way of approaching patients and customers. But now we must adopt new models of influence to stay relevant in a far more complex world.
Our traditional model of advertising works to elicit an emotional response, to try and change a perception. We have done this by making a brand stand for something, usually a set of implicit values. However, to obtain a behavioural change, we must stop talking about what brands stand for and start talking about what brands do – and how they can behave.
That requires a thorough re-evaluation of the role of medical and marketing communications.
Debate and influencing choices
People need to be involved to make a change.
Presenting lots of information and incentives to change is not enough. If you want someone to go from using one medicine to using another medicine, you have to involve them in a decision that is right for their health.
A current debate about organ donation in Wales illustrates the point about behaviour.
The Welsh Assembly is currently deciding whether to change the way the choice of organ donation is presented in order to increase the number of registered donors. Under the proposed system, people would have to ‘opt-out’ of organ donation as opposed to the current ‘opt-in’ rule. Why the need for this change? Because people will go with the default option to ‘opt-in’ rather than ‘opt-out’.
Changing this default option would help save more lives – though there is an ethical debate to be had, and the law must be changed to accommodate this change. But this is a clear example of how a choice is presented has a major bearing on the eventual decision.
Commercial success is achieved by ensuring our customers, end-users and those that influence them truly engage with our marketing.
However, the places that our customers and patients find influence are no longer the same place that we, predominantly, try and influence them from. Conventional sales and marketing models have been dominated by rationalised hard-sell thinking. Hard metrics of coverage/frequency backed-up by customer message recall.
Through traditional analysis methods, we believed that people were going to behave the way they said they would. We have looked to create insightful and engaging communication – then have been shocked when customers aren’t loyal to the brand because of pressures such as pricing. We should be creating models of influence that reflect how healthcare professionals find motivation in what to prescribe or recommend. We should know how patients interact with their healthcare professional – whoever they may be.
Maximising the sales opportunity comes from understanding the real network of influence that surrounds physician/patient choice. It is simply not going to be enough to try and work within the model we have had for the last 20-30 years.
Sales force reductions, compliance issues, de-coupling of marketing and medical and a loss of opportunities to engage, have altered the customers’ perception of how engaged we are with them and how relevant we are to their world.
True engagement comes about through two-way, mutually beneficial conversations.
This has always been the case, but the digital era means where that conversation happens has changed completely.
The evolution of the influence model
For decades we have used ‘Influence Pyramids’ to demonstrate the flow of influence on the mind of the customer and on prescribing behaviour towards patients. We then affect this through our communications, advertising, PR, medical education events and publications planning, CRM, and social media. We use these and other methods to influence patients, patient organisations, licensing organisations, health media and professional bodies – who we hope will in turn influence health professional decisions. We push at the patient level from the bottom of the pyramid and we try to influence professionals and their advisors from the top.
Now is the time for the re-evaluation of this model, because it no longer works.
There are three territories from which we can develop a new model:
1: The social world
We are not doing enough to ensure that health and wellness is something that medication is positively associated with. Yet we’re living in a world where 31% of all adults currently rank ‘living without illness’ as their number one health priority.
The opportunity is there, and it’s huge.
Meanwhile, we know that the world’s population is ageing – the median age of all countries across the globe will rise from 29 to 38 by 2050.
By 2050, in the developed world, one in three people will be a pensioner and nearly one in ten will be over 18 (The Economist, 2009).
There is no reason why these people cannot have behaviours associated with better health, through a healthy lifestyle and appropriate medication.
2: The technological world
There are now a number of healthcare apps available for smartphones – these apps range from simple information transfer to apps that enable patients to manage their chronic conditions. But could there be a higher social purpose to such technological innovations? The Mappiness app was developed by the London School of Economics. It is fantastic. The online study, one of the biggest undertaken, creates a map of the nation’s happiness. Users update the system in real time, three-times-a-day. In our own industry, could marketers and medics do similar things to help to assess the needs and behaviours of patients, and disseminate this information for the benefit of all?
People will need tools and data to take charge of their own health. And they are only going to want to engage with us if they trust that we have their best interests at heart. Contrary to received wisdom, people want to share their health details. People are sharing all sorts of information – photographs, video, opinions and advice online. Our own research shows patients are completely unaware their data cannot be shared between hospital and primary care. They expect it to be.
Online communities should be given as much value as offline. Individuals don’t see their lives partitioned into an online and offline world, we engage with both types of activities continuously. In the top five European countries, the percentage of people who claim to use the internet as their first port of call for health information is now more than a third.
They don’t do this after they have visited a pharmacy, or doctor, or after speaking to their friends. What’s more the stats show that this is true across all age groups.
We need to understand the role of new media – touch-screen technology, mobile devices, and the fact that fewer people are consuming media in real time nowadays. Do we truly understand how our customers and patients are behaving
Or do we focus group them in exactly the same way we always did?
3: The media environment
We should start combining the media environment with the technological and social environment we’re in. The position of traditional media and brand channels has changed.
Validated models are starting to appear that show how spending marketing budget outside of sales promotion and advertising will bring ROI – they are behavioural models.
Retail and other sectors are ahead of us, and have examined the role of integrated marketing in their marketing mix. And, they are still using sales representatives. They are still using advertising in the press, radio and outdoor advertising. So, why change? Patients and consumers generally, report being influenced by the same people they always have. Studies show personal recommendations of friends or family, from professionals, are still their highest influence. Physicians and patients alike still rely on a trusted source of influence and information to help them change behaviour. All of it is peer-to-peer and it has totally removed the hierarchy of influence, authority, and geography. People trust strangers now.
So how do we use these to build the new model? Imagine a network of influence around an individual prescriber and patient. The biggest influence on the patient could well be another patient. That patient could have been influenced by a single pharmacist, and that pharmacist is influenced by a physician they saw at a talk.
But actually, these two physicians talk to each other because they are linked on a professional network where they talk about how to manage certain patients – and so the network builds.
Furthermore, there is no reason why our original patient can’t find a point of view from a doctor on a website in the US which gives them medical advice. We must stop shouting to get our ideas down a non-existent pyramid – and start listening – but most of all, understand the role we have to play within the model. We have to find new ways of influencing this model, and with credibility.
From classical to behavioural models
Much of our current commercial activity relies on the principals and theories of classical economics, which assume human beings are rational and behave in a way to maximise their self-interest. But experience shows this isn’t true. Our pharmaceutical world could now benefit from the emerging field of behavioural economics, which combines the disciplines of psychology and economics. When we use social, cognitive, and emotional factors in understanding the economic decisions that individuals and institutions make, we can predict the non-rational behaviour that people are going to have. The simple truth is that people do not behave in the way in which they report they are going to. Seven social observations, first described by the New Economics Foundation (NEF) dictate the way in which we behave:
• Other peoples’ behaviour matters. We copy the actions of others. Success comes from getting customers to copy the way in which our brand behaves
• Habits are important. People rapidly adopt default non-thinking behaviour. So, we have to figure out how ingrained those habits are in the behaviour of the customer and how much we can actually influence
• Self-expectations influence how people behave. People feel uncomfortable when they experience a clash with their values. What customers say about themselves to other people is most important to them
• People are motivated to ‘do the right thing’. Doing the right thing is often more important than making money. Health professionals are generally not motivated by entrepreneurial zeal
• People are loss averse. Natural conservatism is the social norm. Try and convince people that there is a much more effective and appropriate way of dealing with a disease, and many people won’t want to lose what they already have
• People are bad at computation when making decisions. People do not think rationally – especially under pressure. Yet we market research them and develop programmes in a totally rational way.
Conclusion
The need to marry ideas with utility has never been greater. We will do this by putting integration at the centre. It’s a mindset where language, data, behaviour, attitudes, channels and audiences are all understood to produce authentic marketing. Delivering on this is our single biggest opportunity.
Andy Hayley is managing director of TBWA\Paling Walters. Follow him on Twitter: @tbwa_pw and @andy_hayley
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